Incidence and mortality of nonmelanoma skin cancer in Europe: current trends and challenges

Vol.:(0123456789)
Clinical and T ansla ional Oncology
h ps://doi.o g/10.1007/s12094-025-03985-z
RESEARCH ARTICLE
Incidence andmo ali y o nonmelanoma skin cance inEu ope:
cu en ends andchallenges
Me cedesSendín‑Ma ín1 · Rocío C.Bueno‑Molina1,4 · Juan‑Ca losHe nández‑Rod íguez1 · LucíaCayuela2 ·
Au elioCayuela3 · José‑JuanPe ey a‑Rod íguez1,4
Recei ed: 25 May 2025 / Accep ed: 20 June 2025
© The Au ho (s) 2025
Abs ac
Pu pose Nonmelanoma skin cance (NMSC), p edominan ly basal cell ca cinoma (BCC) and squamous cell ca cinoma
(SCC), ep esen s he mos common malignancy among ai -skinned popula ions. While BCC is a ely a al, SCC con ibu es
signi ican ly o NMSC- ela ed mo ali y. This s udy aimed o in es iga e long- e m ends in NMSC incidence and SCC
mo ali y ac oss 28 Eu opean coun ies om 1992 o 2021, ocusing on egional, sex-speci ic, and age- ela ed a ia ions.
Me hods/pa ien s A longi udinal ecological analysis was conduc ed using he Global Bu den o Disease (GBD) da abase.
Age-s anda dized incidence a es (ASIRs) o NMSC and age-s anda dized mo ali y a es (ASMRs) o SCC we e calcu-
la ed based on he 2013 Eu opean S anda d Popula ion. Tempo al ends we e e alua ed using joinpoin eg ession, and
age–pe iod–coho (APC) models we e employed o disen angle independen e ec s on SCC mo ali y.
Resul s Eu ope egis e ed o e 27 million NMSC cases be ween 1992 and 2021. O e all ASIRs sligh ly declined, al hough
inc easing incidence was obse ed in indi iduals unde 45 in Cen al and No he n Eu ope. SCC accoun ed o mo e han
570,000 dea hs, wi h o e all ASMRs dec easing—pa icula ly among women and younge men. Howe e , mo ali y ose
in men aged o e 75, no ably in No he n and Wes e n Eu ope. APC analysis indica ed ele a ed SCC mo ali y in coho s
bo n be o e 1940, wi h a no able e e sal in No he n Eu opean males bo n a e 1960, who exhibi ed inc easing mo ali y.
Pe iod e ec s u he con i med a ecen ise in SCC mo ali y among hese popula ions.
Conclusions Al hough NMSC incidence appea s o be s abilizing o declining in much o Eu ope, inc easing ends in
younge indi iduals and ising SCC mo ali y in olde men—especially in No he n Eu ope—highligh he need o age- and
egion-speci ic p e en ion and sc eening s a egies. Imp o ed cance egis y ha moniza ion emains essen ial o guiding
e ec i e public heal h in e en ions.
Keywo ds Non melanoma skin cance · Basal cell ca cinoma· Squamous cell ca cinoma· Incidence· Mo ali y· Eu ope
In oduc ion
Nonmelanoma skin cance (NMSC) is he mos common
ype o cance among ai -skinned popula ions wo ldwide
[1]. This g oup o neoplasms mainly includes basal cell
ca cinoma (BCC) and squamous cell ca cinoma (SCC),
al hough i also comp ises less common umo s, such as
Me kel cell ca cinoma [2]. Despi e i s high p e alence,
mo ali y associa ed wi h NMSC has his o ically been low,
pa icula ly in he case o BCC [3]. Howe e , SCC p esen s
a di e en pa e n, wi h inc easing mo ali y a es in ce ain
popula ion subg oups, such as immunocomp omised indi-
iduals and olde adul s [2].
In Eu ope, NMSC incidence a es ha e shown a s eady
inc ease in he ecen decades [4], wi h p ojec ions indica ing
* Rocío C. Bueno-Molina
[email p o ec ed]
1 Depa men o De ma ology, Vi gen del Rocío Uni e si y
Hospi al, Se ille, Spain
2 Depa men o In e nal Medicine, Hospi al Se e o Ochoa,
Leganés, Spain
3 Uni o Public Heal h, P e en ion andHeal h P omo ion,
Sou h Se ille Heal h Managemen A ea, Se ille, Spain
4 Depa men o Medicine, Uni e si y o Se ille, Se ille, Spain
Clinical and T ansla ional Oncology
a po en ial inc ease o app oxima ely 40% in he coming
decades, d i en by ac o s such as UV exposu e and demo-
g aphic changes, pa icula ly he aging popula ion [5]. This
inc ease is pa icula ly no able in No he n Eu opean coun-
ies, whe e NMSC incidence a exceeds ha o sou he n
egions. Acco ding o a ailable da a, incidence a ies om
mo e han 100 cases pe 100,000 people in some egions
o ewe han 50 cases pe 100,000 in o he s, highligh ing
signi ican geog aphic dispa i ies wi hin he con inen [6].
Al hough he incidence o NMSC con inues o ise,
mo ali y a es ha e emained ela i ely s able, e lec ing
imp o emen s in ea ly diagnosis and he de elopmen o
nonope a i e ea men modali ies [7]. Howe e , sligh
inc eases ha e been obse ed in speci ic subg oups, no ably
among women bo n a e he 1970s in ce ain coun ies [8].
These di e ences e lec bo h gene ic and en i onmen al ac-
o s, including he e ec i eness o ea ly de ec ion p og ams
and ea men s a egies [9, 10].
A he con inen al le el, he quali y o epidemiologi-
cal da a and egis y sys ems a ies signi ican ly, hinde -
ing di ec compa isons be ween coun ies. Al hough some
na ions ha e obus NMSC da a collec ion sys ems, o he s
ace limi a ions in s anda diza ion and he a ailabili y o
in o ma ion disagg ega ed by umo sub ypes. These dis-
pa i ies ep esen a majo challenge in designing e ec i e
p e en ion policies [4, 11–15].
This s udy aims o comp ehensi ely analyze NMSC inci-
dence and mo ali y ends in 28 Eu opean coun ies om
1992 o 2021. Fo mo ali y analysis, he s udy will ocus
only on SCC as i accoun s o he majo i y o NMSC- ela ed
dea hs, as highligh ed in p e ious s udies [8, 16, 17]. By
explo ing a ia ions by gende , age, and geog aphic egion,
he s udy aims o p o ide a mo e comple e pe spec i e on
he disease's impac h oughou Eu ope, he eby con ibu -
ing aluable insigh s o he de elopmen o e ec i e public
heal h s a egies.
Ma e ials andme hods
A longi udinal ecological s udy was pe o med o in es i-
ga e pa e ns in he incidence and mo ali y o nonmelanoma
skin cance (NMSC) ac oss 28 Eu opean coun ies o e he
pe iod 1992 o 2021. In o ma ion on NMSC incidence and
mo ali y was ob ained om he Global Bu den o Disease
(GBD) da abase (h ps:// ghdx. heal hda a. o g/). BCC and
SCC cases we e speci ically iden i ied using ICD-9 code
173 and ICD-10 code C44, co e ing all indi iduals (bo h
sexes) in he selec ed coun ies. The coun ies we e ca ego-
ized in o ou geog aphic egions—Cen al and Eas e n
Eu ope, No he n Eu ope, Sou he n Eu ope, and Wes e n
Eu ope—acco ding o he GLOBOCAN 2020 classi ica-
ion [18]. To ensu e eliable epo ing o heal h es ima es,
he s udy adhe ed o he GATHER (Guidelines o Accu a e
and T anspa en Heal h Es ima e Repo ing) [19] s anda ds
and ollowed he STROBE (S eng hening he Repo ing o
Obse a ional S udies in Epidemiology) [20] guidelines o
obse a ional esea ch.
S a is ical analysis
Incidence and mo ali y da a we e di ided in o h ee age
g oups: unde 45yea s, 45 o 74yea s, and o e 75yea s.
This s a i ica ion was based on p e ious esea ch ha sup-
po s his classi ica ion due o di e ences in disease la ency
and biological ac o s [21].
Age-s anda dized incidence a es (ASIRs) and age-s and-
a dized mo ali y a es (ASMRs) we e de e mined using he
di ec s anda diza ion me hod, e e encing he 2013 Eu o-
pean S anda d Popula ion [22]. ASMRs o BCC we e no
calcula ed due o i s esidual mo ali y [2, 8, 23]. ASIRs and
ASMRs we e epo ed sepa a ely by sex and age g oup and
exp essed as a es pe 100,000 indi iduals. The da a p ocess-
ing and analysis we e conduc ed wi h R s a is ical so wa e
( e sion 4.3.2; h ps:// www. - p oje c . o g/).
T ends in ASIRs and ASMRs o e ime we e e alua ed
using Joinpoin eg ession so wa e ( e sion 5.2.0.0; h ps://
su e illan ce. cance . go / joinp oin ). This me hod calcula ed
bo h he annual pe cen age change (APC) and he a e age
annual pe cen age change (AAPC) o each segmen o he
s udy pe iod (1992–2021). The a e changes we e deemed
s a is ically signi ican i he APC o AAPC was g ea e
o less han ze o (p < 0.05). S able ends we e iden i ied
when no signi ican change was obse ed. A maximum o
7 joinpoin s was pe mi ed, and pai wise compa isons we e
pe o med o de e mine i ends di e ed be ween men and
women.
The independen e ec s o age, pe iod, and coho
(age–pe iod–coho analysis, A–P–C) on mo ali y a es
we e assessed using he coho analysis ool de eloped by
he Na ional Cance Ins i u e (h ps:// analy sis o ols. cance .
go / apc/) [24]. Wald es s we e applied o e alua e he s a-
is ical signi icance o he indings. S a is ical signi icance
was conside ed when he p alue was less han 0.05.
Resul s
NMSC incidence
Du an e he s udy pe iod om 1992 o 2021, Eu ope
eco ded an es ima ed o al o 27,143,489 cases o NMSC,
wi h 23,356,291 BCC cases (86%) and 3,787,198 SCC
(14%) cases.
A sligh dec ease in ASIRs was obse ed a he global
le el in Eu ope o women (AAPC = −0.12; 95% CI −0.22
Clinical and T ansla ional Oncology
o -0.02) du ing he s udy pe iod (Table1). Howe e , no
all egions ollowed his end, wi h he analysis showing a
sligh inc ease in incidence in Cen al and Eas e n Eu ope
o bo h men (AAPC = 0.12; 95% CI 0.05 o 0.20) and
women (AAPC = 0.19; 95% CI 0.03 o 0.35). When s a i-
ying he da a by age, i is no ewo hy ha his inc ease was
p ima ily d i en by he younge popula ion (< 45yea s)
(AAPC = 0.20; 95% CI 0.14 o 0.26 o men; and = 0.26;
Table 1 Joinpoin Analysis Resul s o NMSC Incidence in Eu opean coun ies (1992–2021) by sex
Loca ion
MENWOMEN
JP AAPC 1992-
2021 APCJPAAPC1992-2021 APC
Aus ia5
0.61 (0.43;
0.78)*
1992 - 1995: -1.45 (-2.21;-0.69)*
1995 - 2006:0.25(0.14;0.36)*
2006 - 2010: -2.68 (-3.33;
-2.03)*
2010 - 2015:0.20 (-0.20;0.60)
2015 - 2018:8.77(7.57;9.99)*
2018 - 2021:1.30(0.81;1.80)*
50.38(0.26;0.5)*
1992 - 1995: -1.44 (-1.94;-0.94)*
1995 - 2006:0.22(0.14;0.29)*
2006 - 2010: -3.81 (-4.28;-3.34)*
2010 - 2015: -0.18 (-0.49;0.13)
2015 - 2019: 7.54 (7.06;8.02)*
2019 - 2021:0.21 (-0.61;1.03)
Belgium3
0.14 (0.1;
0.19)*
1992 -2006: 0.05 (0.03;0.08)*
2006 - 2010: -1.92 (-2.16;-1.68)*
2010 - 2015:2.42(2.28;2.57)*
2015 - 2021: -0.14 (-0.21;-0.07)*
30.17(0.12;0.23)*
1992 - 2005:0.17(0.13;0.20)*
2005 - 2010: -1.08 (-1.30;-0.86)*
2010 - 2015:1.48(1.26;1.7)*
2015 - 2021:0.16(0.05;0.27)*
Bulga ia 30.58 (0.53;
0.64)*
1992 - 1999:4.36(4.24;4.48)*
1999 - 2016: -0.02 (-0.04;0.00)
2016 - 2019:3.56(3.11;4.02)*
2019 - 2021: -1.09 (-1.13;-1.05)*
31.05(1.01;1.09)*
1992 - 1999:4.14(4.06;4.23)*
1999 - 2016: -0.00 (-0.02;0.01)
2016 - 2019:2.4 (2.1;2.71)*
2019 - 2021: -2.61 (-2.89;-2.32)*
C oa ia 40.21 (0.18;
0.24)*
1992 - 1995: -0.21 (-0.35;-0.06)*
1995 - 2000:0.78(0.70;0.87)*
2000 - 2015:0.08(0.07;0.09)*
2015 - 2019:0.42(0.32;0.52)*
2019 - 2021: -0.03 (-0.22;0.16)
60.08(0.06;0.1)*
1992 - 1995:0.12(0.03;0.20)*
1995 - 2000: -0.94 (-0.99;-0.89)*
2000 - 2005:0.76(0.71;0.81)*
2005 - 2010: -0.52 (-0.57;-0.48)*
2010 - 2015:0.36(0.31;0.41)*
2015 - 2018:1.09(0.00;1.23)*
2018 - 2021:0.17(0.10;0.23)*
Cyp us 30.22 (0.16;
0.28)*
1992 - 2011:0.02 (-0.00;0.04)
2011 - 2014:1.63(1.21;2.06)*
2014 - 2017:0.33 (-0.10;0.77)
2017 - 2021:0.03 (-0.12;0.18)
4-0.02 (-0.04; -0.0)
1992 -2001: -0.02(-0.05;0.00)
2001 - 2005: -0.19 (-0.31;-0.07)*
2005 - 2010:0.10(0.03;0.17)*
2010 - 2015: -0.31 (-0.36;-0.26)*
2015 - 2021:0.23(0.20;0.25)*
Czechia3
-1.16 (-1.37;
-0.96)*
1992 - 1999:4.69(4.37;5.02)*
1999 - 2016:1.29(1.22;1.36)*
2016 - 2019: -12.48 (-13.81;-
11.13)*
2019 - 2021: -21.28 (-22.81;-
19.71)*
2-1.29 (-1.45; -
1.12)*
1992 - 2000:3.94(3.67;4.21)*
2000 - 2019:1.13(1.07;1.19)*
2019 - 2021: -36.20 (-37.66;-
34.71)*
Clinical and T ansla ional Oncology
Table 1 (con inued)
Denma k4
-0.69 (-0.81;
-0.56)*
1992 - 2002:1.47(1.38;1.55)*
2002 - 2008:0.23(0.01;0.45)*
2008 - 2011: -1.56 (-2.49;-0.00)*
2011 - 2015: -7.05 (-7.51;-6.59)*
2015 - 2021: -0.32 (-0.49;-0.15)*
6-1.04 (-1.16; -
0.92)*
1992 -1999: 2.16 (2.07;2.25)*
1999 - 2003:1.35(1.03;1.68)*
2003 - 2006:0.21 (-0.40;0.83)
2006 - 2011: -4.80 (-5.00;-4.61)*
2011 - 2014: -6.71 (-7.36;-6.05)*
2014 - 2017: -2.08 (-2.80;-1.36)*
2017 - 2021:0.12 (-0.11;0.34)
Es onia4
-0.29 (-0.34;
-0.24)*
1992 - 2000:0.49(0.43;0.55)*
2000 - 2004:1.54(1.28;1.79)*
2004 - 2010:0.55(0.45;0.66)*
2010 - 2015: -4.50 (-4.63;-4.36)*
2015 - 2021:0.20(0.12;0.27)*
6-0.36 (-0.38; -
0.33)*
1992 - 2000:0.72(0.70;0.73)*
2000 - 2004:2.34(2.28;2.40)*
2004 - 2008:0.63(0.57;0.69)*
2008 - 2011: -0.87 (-0.98;-0.76)*
2011 - 2014: -7.40 (-7.51;-7.29)*
2014 - 2017: -0.96 (-10917.00;-
0.84)*
2017 - 2021:0.20(0.16;0.24)*
Finland5
-0.04 (-0.04;
-0.03)*
1992 - 1995: -0.01 (-0.03;0.02)
1995 - 2000: -0.18 (-0.19;-0.16)*
2000 - 2005:0.19(0.18;0.21)*
2005 - 2011: -0.06 (-0.07;-0.05)*
2011 - 2014: -0.19 (-0.23;-0.16)*
2014 - 2021: -0.02 (-0.03;-0.02)*
40.03 (-0.02;0.08)
1992 - 1995: -0.23 (-0.52;0.06)
1995 - 2004:0.20(0.13;0.26)*
2004 - 2013: -0.22 (-0.28;-0.16)*
2013 - 2018: -0.01 (-0.17;0.15)
2018 - 2021:0.61(0.37;0.86)*
F ance 5-0.71 (-0.91;
-0.51)*
1992 - 2000:1.82(1.69;1.94)*
2000 - 2003: -1.97 (-2.94;-0.00)*
2003 - 2006: -3.54 (-4.51;-2.56)*
2006 - 2009: -5.46 (-6.45;-4.46)*
2009 - 2012: -0.60 (-1.6;0.47)
2012 - 2021:0.04 (-0.05;0.13)
5-1.04 (-1.12; -
0.95)*
1992 -1997: 0.15 (-0.00;0.31)
1997 - 2001: -1.33 (-1.66;-0.00)*
2001 - 2005: -4.56 (-4.89;-4.22)*
2005 - 2009: -2.42 (-2.78;-2.07)*
2009 - 2015: -0.27 (-0.43;-0.11)*
2015 - 2021:0.74(0.63;0.86)*
Ge many4
0.68 (0.25;
10.99)*
1992 - 2004:1.35(1.03;1.66)*
2004 - 2010: -0.65 (-
16226.00;0.34)
2010 - 2015:16.06
(14.80;17.33)*
2015 - 2019: -15.61 (-16.96;-
14.24)*
2019 - 2021:0.40 (-0.32;0.41)
40.79(0.37;12)*
1992 - 2004:1.42(1.15;1.69)*
2004 - 2010: -0.62 (-1.52;0.28)
2010 - 2015:15.57
(14.34;16.81)*
2015 - 2019: -14.84 (-16.21;-
13.44)*
2019 - 2021:0.72 (-2.97;4.55)
G eece 60.03 (0.02;
0.03)*
1992 -1995: 0.13 (0.12;0.15)*
1995 - 2000: -0.03 (-0.04;-0.02)*
2000 - 2005:0.12(0.11;0.12)*
2005 - 2010: -0.02 (-0.03;-0.01)*
2010 - 2015:0.08(0.07;0.08)*
2015 - 2019: -0.08 (-0.09;-0.07)*
2019 - 2021:0.01 (-0.01;0.03)
40.04(0.0; 0.08)
1992 - 1995: -0.13 (-0.33;0.07)
1995 - 2005:0.23(0.20;0.27)*
2005 - 2009: -0.27 (-0.45;-0.09)*
2009 - 2018: -0.10 (-0.13;-0.06)*
2018 - 2021:0.40(0.24;0.57)*
Hunga y2
-0.2 (-0.23; -
0.17)*
1992 - 1995:0.42(0.21;0.62)*
1995 - 2000: -1.57 (-1.70;-1.45)*
2000 - 2021:0.04(0.03;0.05)* 3-0.2 (-0.25; -
0.15)*
1992 - 1996: -0.09 (-0.23;0.05)
1996 - 1999: -2.30 (-2.73;-1.86)*
1999 - 2015:0.02(0.01;0.04)*
2015 - 2021:0.18(0.11;0.25)*
Clinical and T ansla ional Oncology
95% CI 0.13 o 0.39 o women) (Supplemen a y Table1 ).
De ailed in o ma ion on he ASIRs o NMSC om he 28
Eu opean coun ies included in he s udy in ≥ 45yea s old
can be ound in Supplemen a y Tables2 and 3.
Table 1 (con inued)
I eland 4 -1.51 (-1.57;
-1.45)*
1992 - 2003:0.98(0.95;1.01)*
2003 - 2006: -0.36 (-0.77;0.06)
2006 - 2010: -6.98 (-7.18;-6.79)*
2010 - 2014: -5.87 (-6.09;-5.66)*
2014 - 2021: -0.10 (-0.15;-0.04)*
5-1.75 (-1.96; -
1.54)*
1992 - 2000:1.10(0.00;1.25)*
2000 - 2003:3.46(2.15;4.79)*
2003 - 2006:0.22 (-0.97;1.42)
2006 - 2010: -11.61 (-12.18;-
11.03)*
2010 - 2014: -5.49 (-6.18;-4.78)*
2014 - 2021:0.15 (-0.05;0.34)
I aly3-0.01 (-0.07;
0.05)
1992 - 2009:0.96(0.93;0.98)*
2009 - 2015:0.06 (-0.07;0.19)
2015 - 2019: -4.28 (-4.55;-4.00)*
2019 - 2021:0.29 (-0.30;0.88)
30.28(0.22;0.35)*
1992 - 2009:1.15(1.13;1.17)*
2009 - 2015:0.32(0.19;0.45)*
2015 - 2019: -3.61 (-3.89;-3.33)*
2019 - 2021:0.83(0.24;1.42)*
La ia3
0.12 (0.1;
0.13)*
1992 - 2005:0.02(0.01;0.03)*
2005 - 2010:0.71(0.64;0.78)*
2010 - 2015: -0.23 (-0.30;-0.17)*
2015 - 2021:0.13(0.09;0.16)*
40.3 (0.28; 0.32)*
1992 - 2001: -0.02 (-0.04;-0.01)*
2001 - 2006:0.69(0.63;0.74)*
2006 - 2010:1.09(1.01;1.17)*
2010 - 2014:0.43(0.35;0.52)*
2014 - 2021: -0.09 (-0.11;-0.07)*
Li huania4
0.01 (-0.03;
0.06)
1992 - 2001:0.07(0.03;0.10)*
2001 - 2004:2.26(1.87;2.65)*
2004 - 2010:1.14(1.06;1.22)*
2010 - 2015: -2.64 (-2.75;-2.53)*
2015 - 2021: -0.06 (-0.12;0.00)
3-0.19 (-0.28; -
0.1)*
1992 - 2000:0.01 (-0.13;0.16)
2000 - 2010:1.95(1.84;2.06)*
2010 - 2015: -5.02 (-5.37;-4.67)*
2015 - 2021:0.13 (-0.07;0.34)
Luxembou g 50.03 (0.02;
0.04)*
1992 - 1995:0.04 (-0.02;0.10)
1995 - 2000: -0.17 (-0.21;-0.14)*
2000 - 2005:0.36(0.33;0.40)*
2005 - 2010: -0.18 (-0.21;-0.15)*
2010 - 2015:0.18(0.15;0.20)*
2015 - 2021: -0.05 (-0.06;-0.03)*
30.03 (-0.01;0.07)
1992 - 1996: -0.11 (-0.28;0.07)
1996 - 2005:0.19(0.13;0.24)*
2005 - 2017: -0.18 (-0.21;-0.15)*
2017 - 2021:0.45(0.31;0.58)*
Mal a4
-0.99 (-1.11;
-0.87)*
1992 - 2001:0.13(0.01;0.24)*
2001 - 2011:0.59(0.50;0.69)*
2011 - 2015: -2.90 (-3.33;-2.46)*
2015 - 2018: -6.70 (-7.55;-5.84)*
2018 - 2021: -1.16 (-1.61;-0.00)*
5-0.38 (-0.44; -
0.32)*
1992 - 1994:1.70(1.12;2.28)*
1994 - 2001:0.04 (-0.05;0.13)
2001 - 2010:1.28(1.23;1.33)*
2010 - 2015: -1.13 (-1.25;-0.00)*
2015 - 2019: -5.53 (-5.73;-5.33)*
2019 - 2021:1.18(0.00;1.61)*
Ne he lands3 0.65 (0.55;
0.74)*
1992 - 1999:3.41(3.21;3.60)*
1999 - 2005:0.51(0.23;0.79)*
2005 - 2019: -0.19 (-0.25;-0.14)*
2019 - 2021: -2.52 (-3.44;-1.59)*
10.36(0.29;0.42)*1992 - 2000:2.47(2.24;2.69)*
2000 - 2021: -0.44 (-0.48;-0.39)*

Clinical and T ansla ional Oncology
Table 1 (con inued)
Poland 41.03 (1;
1.08)*
1992 - 2003: -0.09 (-0.11;-0.07)*
2003 - 2006:1.26(0.00;1.56)*
2006 - 2009:8.90(8.61;9.18)*
2009 - 2012:0.86(0.63;1.09)*
2012 - 2021: -0.10 (-0.12;-0.08)*
41.1 (1.06; 1.14)*
1992 - 2003: -0.08 (-0.10;-0.06)*
2003 - 2006:1.13(0.00;1.41)*
2006 - 2009:9.13(8.87;9.40)*
2009 - 2012:0.75(0.53;0.97)*
2012 - 2021:0.09(0.07;0.10)*
Po ugal 6 2.21 (2.08;
2.34)*
1992 - 1995:0.09 (-0.49;0.68)
1995 - 2001:2.10(1.87;2.33)*
2001 - 2004:3.85(2.96;4.75)*
2004 - 2010:2.12(1.95;2.29)*
2010 - 2014:6.13(5.80;6.46)*
2014 - 2017:1.01(0.00;1.58)*
2017 - 2021: -0.02 (-0.19;0.15)
40.99(0.91;1.08)*
1992 - 1996:0.11 (-0.13;0.35)
1996 - 1999:2.08(1.38;2.79)*
1999 - 2010:0.83(0.78;0.88)*
2010 - 2014:2.97(2.70;3.25)*
2014 - 2021:0.17(0.11;0.24)*
Romania2
0.96 (0.94;
0.98)*
1992 - 1999:3.92(3.86;3.98)*
1999 - 2012:0.08(0.06;0.10)*
2012 - 2021: -0.04 (-0.07;-0.01)*
30.97 (0.92;
10282.0)*
1992 - 1999:3.79(3.71;3.87)*
1999 - 2002:0.43 (-0.06;0.92)
2002 - 2012: -0.06 (-0.10;-0.02)*
2012 - 2021:0.15(0.11;0.19)*
Slo akia3
-0.52 (-0.59;
-0.45)*
1992 - 2005:0.50(0.45;0.55)*
2005 - 2010:3.03(2.76;3.29)*
2010 - 2015: -7.20 (-7.44;-6.96)*
2015 - 2021:0.16(0.02;0.30)*
3-0.52 (-0.58; -
0.45)*
1992 - 2005:0.22(0.17;0.26)*
2005 - 2010:3.23(2.97;3.50)*
2010 - 2015: -6.88 (-7.12;-6.64)*
2015 - 2021:0.32(0.18;0.47)*
Slo enia2
1.33 (1.25;
1.42)*
1992 - 1999:6.42(6.19;6.66)*
1999 - 2019:0.83(0.79;0.86)*
2019 - 2021: -10.26 (-11.15;-
9.36)*
20.89(0.79;0.99)*
1992 - 2000:5.10(4.90;5.29)*
2000 - 2019:0.81(0.77;0.85)*
2019 - 2021: -13.72 (-14.81;-
12.61)*
Spain4
-0.5 (-0.75; -
0.24)*
1992 - 2006:0.71(0.62;0.81)*
2006 - 2010: -2.88 (-3.76;-1.99)*
2010 - 2015: -4.86 (-5.44;-4.29)*
2015 - 2018:3.65(1.69;5.66)*
2018 - 2021:0.49 (-0.41;1.39)
3-0.63 (-0.89; -
0.37)*
1992 - 2006:0.92(0.81;1.03)*
2006 - 2011: -3.54 (-4.19;-2.89)*
2011 - 2014: -6.77 (-8.86;-4.62)*
2014 - 2021:1.13(0.00;1.44)*
Sweden 30.32 (0.23;
0.42)*
1992 - 1997:3.00(2.68;3.33)*
1997 - 2012:0.10(0.05;0.16)*
2012 - 2019:1.23(1.04;1.41)*
2019 - 2021: -7.47 (-8.43;-6.49)*
30.75(0.65;0.85)*
1992 - 1998:3.10(2.87;3.34)*
1998 - 2013:0.16(0.10;0.21)*
2013 - 2019:2.45(2.20;2.71)*
2019 - 2021: -6.50 (-7.50;-5.48)*
Uni ed
Kingdom5-0.43 (-0.48;
-0.39)*
1992 - 1994:2.77(2.37;3.17)*
1994 - 2006:0.14(0.12;0.17)*
2006 - 2009:2.13(1.81;2.46)*
2009 - 2015: -0.36 (-0.42;-0.29)*
2015 - 2019: -5.97 (-6.11;-5.83)*
2019 - 2021: 0.31 (-0.00;-0.62)
5-0.33 (-0.42; -
0.24)*
1992 -1994: 3.09 (2.45;3.73)*
1994 - 2006:0.25(0.21;0.29)*
2006 - 2009:4.09(3.52;4.67)*
2009 - 2015: -0.16 (-0.28;-0.04)*
2015 - 2019: -7.48 (-7.74;-7.23)*
2019 - 2021: 0.69 (0.10; 1.27)*
Clinical and T ansla ional Oncology
Fou end changes in NMSC incidence we e obse ed
in Eu ope (Fig.1). The i s phase showed an inc ease om
1992 o 2000 (APC = 1.09; 95% CI 0.93 o 1.25), ollowed
by a sligh decline un il 2011 (APC = −0.12; 95% CI −0.22
o -0.02). This was succeeded by a signi ican ise un il 2015
(APC = 2.28; 95% CI 1.68 o 2.89), a e which a ma ked
decline was obse ed (APC = −4.28; 95% CI −4.83 o
−3.72). This gene al decline appea s o ha e s abilized since
2019. Howe e , when s a i ying he da a by egions, we
obse e ha in young pa ien s (< 45yea s) om No he n
Eu ope, ASIRs do no ollow his end. Ins ead, hey show
an inc ease since 2019, bo h in men (APC = 0.92; 95% CI
0.65 o 1.2) and in women (APC = 0.49; 95% CI 0.18 o
0.79) (Supplemen a y Table1and Supplemen a y Fig.1.
This inc ease in NMSC incidence in No he n Eu ope since
2019 was no obse ed in olde pa ien s. In ac , a signi ican
decline in NMSC incidence was ound in men o e 75yea s
(APC = −2.3; 95% CI −3.04 o −1.55), as well as in women
(APC = −1.79; 95% CI −2.99 o −0.58) (Supplemen a y
Table3).
SCC mo ali y
A o al o 570,525 dea hs om SCC occu ed in Eu ope
be ween 1992 and 2021. S a i ying by sex, a he Eu opean
le el, he ASMRs o SCC showed a signi ican dec ease
in women, om 1.31 cases pe 100,000 inhabi an s du ing
he pe iod 1992–1996 o 1 case pe 100,000 inhabi an s
in 2017–2021 (AAPC = −1.18; 95% CI −1.41 o −0.95)
(Table2). Among men, his dec ease was obse ed in
hose unde 45yea s old (AAPC = −1.76; 95% CI −2.31
o −1.21), and in hose aged 45 o 74yea s (Supplemen a y
Table 1 (con inued)
CENTRAL/
EASTERN 50.12 (0.05;
0.2)*
1992 - 1999: 2.6(2.5;2.7)*
1999 - 2005:0.23(0.09;0.37)*
2005 - 2010: 1.99 (1.81;2.18)*
2010 - 2016:0.21(0.10;0.33)*
2016 - 2019: -3.73 (-4.2;-3.25)*
2019 - 2021: -7.47 (-7.95;-6.99)*
40.19(0.03;0.35)*
1992 -1999: 2.12 (1.91;2.32)*
1999 - 2006:0.37(0.14;0.61)*
2006 - 2009:2.56(1.26;3.88)*
2009 - 2019:0.30(0.20;0.41)*
2019 - 2021: -10.58 (-11.66;-
9.48)*
NORTHERN 4-0.35 (-0.52;
-0.19)*
1992 - 1994:2.79(1.18;4.42)*
1994 - 2010:0.40(0.34;0.46)*
2010 - 2015: -0.80 (-1.19;-0.42)*
2015 - 2019: -4.00 (-4.59;-3.40)*
2019 - 2021: -0.89 (-2.11;0.35)
5-0.28 (-0.36; -
0.2)*
1992 - 1995:2.18(1.86;2.49)*
1995 - 2006:0.48(0.43;0.52)*
2006 - 2009:1.68(1.11;2.24)*
2009 - 2015: -0.70 (-0.82;-0.58)*
2015 - 2019: -4.84 (-5.11;-4.58)*
2019 - 2021: -0.37 (-0.94;0.20)
SOUTHERN 4-0.1 (-0.19; -
0.01)*
1992 - 2000:0.71(0.60;0.82)*
2000 - 2005:1.14(0.00;1.42)*
2005 - 2009: -0.25 (-0.65;0.15)
2009 - 2019: -1.29 (-1.36;-1.22)*
2019 - 2021: -0.19 (-0.95;0.57)
4-0.05 (-0.17;0.06)
1992 - 2000:0.89(0.78;1.01)*
2000 - 2005:1.23(0.00;1.54)*
2005 - 2008: -0.18 (-1.08;0.73)
2008 - 2018: -1.35 (-1.44;-1.27)*
2018 - 2021: -0.17 (-0.62;0.28)
WESTERN40.0 (-0.22;
0.23)
1992 - 2006:0.99(0.79;1.18)*
2006 - 2010:3.1 (1.33;4.9)*
2010 - 2013: -1.87 (-5;1.36)
2013 - 2016:1.48 (-1.62;4.68)
2016 - 2021: -2.15 (-2.82;-1.48)*
1-0.09 (-0.23;0.06) 1992 - 2016:0.17(0.04;0.29)*
2016 - 2021: -2.66 (-3.91;-1.4)*
UE28 4-0.11 (-0.25;
0.03)
1992 - 2000:1.29(1.12;1.45)*
2000 - 2011: -0.22 (-0.32;-0.12)*
2011 - 2015:2.45(1.86;3.05)*
2015 - 2019: -4.62 (-5.16;-4.08)*
2019 - 2021: -0.92 (-2.06;0.23)
4-0.12 (-0.22; -
0.02)*
1992 - 1999:1.02(0.00;1.14)*
1999 - 2011:0.01 (-0.04;0.06)
2011 - 2015:2.12(1.74;2.50)*
2015 - 2018: -4.18 (-4.88;-3.47)*
2018 - 2021: -2.05 (-2.42;-1.67)*
AAPC Anual A e age pe cen age change. JP Joinpoin . APC Annual Pe cen age Change and 95% con idence in e al. *p < 0.05
Wes e n coun ies: g een, Sou he n coun ies: ed, No he n coun ies: blue, Cen al and Eas e n coun ies: yellow
Clinical and T ansla ional Oncology
Tables4 and 5). When analyzed by egion, he da a e ealed
ha his decline in ASMRs was no uni o m. Men in Wes e n
Eu ope exhibi ed an o e all inc ease in a es (AAPC = 0.65;
95% CI 0.17 o 11.32) (Table2), which was also obse ed
in women (AAPC = 0.74; 95% CI 0.16 o 13.24) and in men
om No he n Eu ope (AAPC = 1.15; 95% CI 0.15 o 2.17)
aged > 74yea s (Supplemen a y Table6).
Fo No he n Eu ope, he analysis e ealed a highly sig-
ni ican end change in mo ali y, wi h h ee dis inc pe iods
(Fig.2). Ini ially, he e was a s abiliza ion phase in mo al-
i y om 1992 o 2013 (APC = 0.04; 95% CI −0.2 o 0.46),
ollowed by a highly signi ican inc ease om 2013 o 2016
(APC = 13.92; 95% CI 5.44 o 23.09), and a subsequen
decline om 2016 o 2021 (APC = −4.03; 95% CI −5.51 o
−2.52). When s a i ying he da a by sex, i was obse ed
ha he ma ked inc ease in mo ali y be ween 2013 and 2016
was p edominan ly d i en by males (APC = 15.83; 95% CI
5.52 o 27.14), whe eas emales also showed an inc ease,
hough less p onounced (APC = 5.03; 95% CI 3.35 o 6.74)
and o e a b oade pe iod (2010–2017). Mo eo e , when
s a i ying he da a by age (Fig.3), he h ee age g oups
s udied exhibi ed he same ends, bu he inc ease was pa -
icula ly p onounced in males aged > 74yea s (APC = 16.02;
95% CI 5.57 o 27.51).
Con e sely, in Cen al and Eas e n Eu ope, he end
was consis en ly downwa d h oughou he en i e pe iod
(Fig.3), wi h a end change obse ed om 2004, show-
ing a mo e signi ican decline he ea e (APC = −4.96;
95% CI −5.71 o 4.21). When seg ega ing he da a by
sex, he downwa d end was obse ed in bo h g oups bu
became pa icula ly p onounced in women a e 2015
(APC = −12.6; 95% CI −20.33 o −4.12).
Rega ding he A–P–C analysis (Fig.4), a p og essi e
inc ease in mo ali y a es wi h age was obse ed. Con-
ce ning he bi h coho e ec , indi iduals bo n a he
beginning o he cen u y (pa icula ly women) exhibi ed
highe ASMRs, which p og essi ely declined o hose
bo n om 1940 onwa d. When b eaking down he da a by
egion, mo ali y was no ably high among bo h women and
men om Cen al and Eas e n Eu ope bo n a he begin-
ning o he cen u y. A simila , al hough less p onounced,
inc ease in mo ali y was obse ed among women om
Sou he n Eu ope bo n du ing he same pe iod. A educ-
ion in isk was e iden o coho s bo n a e 1940 in
Cen al and Eas e n Eu ope, Sou he n Eu ope, and Wes -
e n Eu ope. Howe e , in No he n Eu ope, he end was
e e sed, wi h he male coho bo n a e 1960 showing
highe a es compa ed o hose bo n ea lie in he cen u y.
Finally, ega ding he pe iod e ec , a gene al downwa d
end in ASMRs has been obse ed among Eu opean men
and women du ing he wen y- i s cen u y. Analyzing by
egions, he excep ion o his end is No he n Eu ope,
whe e a es o bo h sexes ha e ended o ise, pa icula ly
among males, wi h hese inc eases being especially p o-
nounced in coun ies such as he Uni ed Kingdom (Sup-
plemen a y Fig.2). De ailed esul s o he 28 coun ies
included in he mo ali y analysis can be ound in he sup-
plemen a y ma e ial (Supplemen a y Figs.1, 2, 3, 4, and
Supplemen a y Tables1, 2, 3, 4, 5, 6).
Fig. 1 Joinpoin Reg ession Analysis o NMSC Incidence o Bo h Sexes in Fou Eu opean Regions (1992–2021)
Clinical and T ansla ional Oncology
Discussion
The p esen s udy o e s a comp ehensi e analysis o he
incidence and mo ali y ends o NMSC ac oss 28 Eu o-
pean coun ies o e h ee decades. The indings highligh
signi ican geog aphic and demog aphic dispa i ies, unde -
sco ing unique egional a ia ions.
Acco ding o ou esul s, he ASIRs o NMSC in Eu ope
showed a sligh o e all decline. When s a i ying he da a by
egions, a sligh inc ease in NMSC incidence was obse ed
Table 2 Joinpoin Analysis Resul s o SCC Mo ali y in Eu opean coun ies (1992–2021) by sex
Loca ion
MENWOMEN
JP AAPC 1992-
2021 APC JP AAPC 1992-2021APC
Aus ia3 0.21 (-0.18;
0.60)
1992 - 1999: -4.59 (-5.39, -
3.78)*
1999 - 2014:1.75(1.49,2.02)*
2014 - 2019:3.54(2.22,4.88)*
2019 - 2021: -2.22 (-5.81,1.50)
1 0.24 (-0.17;0.66)
1992 - 2001: -3.85 (-5.01, -
2.68)*
2001 - 2021:2.14(1.82,2.46)*
Belgium3 -0.29 (-0.82;
0.24)
1992 -1998: -2.81(-4.15, -
1.46)*
1998 - 2003:4.00(1.56,6.50)*
2003 - 2017:0.23 (-0.08,0.54)
2017 - 2021: -3.49 (-5.05, -
1.91)*
2 -0.48 (-1.04;0.07)
1992 - 1996: -2.54 (-5.05,0.04)
1996 - 2019:0.29(0.12,0.46)*
2019 - 2021: -5.09 (-11.07, 1.30)
Bulga ia 2 -0.17 (-1.56;
1.24)
1992 - 2013:0.45 (-0.11,1.01)
2013 - 2016:6.30 (-6.64,21.05)
2016 - 2021: -6.32 (-8.85, -
3.71)*
3 -2.12 (-3.82; -
0.39)*
1992 - 2013: -2.05 (-2.54, -
1.55)*
2013 - 2016:7.59 (-4.15,20.76)
2016 - 2019: -13.56 (-22.87, -
3.12)*
2019 - 2021:1.53 (-8.93,13.19)
C oa ia4 -2.14 (-3.19;
-1.08)*
1992 - 1995: -7.66 (-11.57, -
3.57)*
1995 - 2011: -1.53 (-1.94, -
1.12)*
2011 - 2015:6.05(1.66,10.63)*
2015 - 2018: -11.14 (-17.65, -
4.12)*
2018 - 2021: -0.77 (-4.39,2.99)
4 -2.29 (-3.68; -
0.88)*
1992 -1997: -6.87(-9.00, -
4.69)*
1997 - 2012: -2.22 (-2.73, -
1.72)*
2012 - 2015:13.96 (3.32,
25.69)*
2015 - 2018: -12.25 (-19.97, -
3.80)*
2018 - 2021:0.71 (-3.94,5.60)
Cyp us 4 -2.72 (-3.42;
-2.01)*
1992 -1997: -7.73(-9.14, -
6.31)*
1997 - 2002: -0.54 (-2.48,1.43)
2002 - 2005: -8.61 (-13.74, -
3.18)*
2005 - 2015:1.40(0.90,1.91)*
2015 - 2021: -3.90 (-4.83, -
2.95)*
4 -2.55 (-3.39; -
1.69)*
1992 - 1996: -7.38 (-9.61, -
5.08)*
1996 - 2002: -2.16 (-3.65, -
0.64)*
2002 - 2005: -6.35 (-12.98, 0.78)
2005 - 2019: -0.27 (-0.57,0.04)
2019 - 2021: -3.75 (-7.45,0.10)
Clinical and T ansla ional Oncology
igilance and ea ly de ec ion. To op imize hese s a egies
o high- isk popula ions—such as younge indi iduals wi h
high UV exposu e o olde adul s wi h occupa ional isk—
ailo ed in e en ions a e needed.
P e ious s udies show ha , o he o al dea hs om
NMSC, he majo i y should be conside ed dea hs om SCC,
gi en ha BCC mo ali y is minimal [8, 16, 17]. The e a e
ew s udies in he li e a u e on NMSC- ela ed mo ali y,
as i is no consis en ly included in egis ies [4, 11]–[14].
Acco ding o ou esul s, a gene al decline in ASMRs was
obse ed in bo h men and women. P e ious s udies ha e
epo ed a sligh decline in NMSC- ela ed ASMRs in Eu o-
pean coun ies such as he Ne he lands [29] and Finland
[30], as well as in non-Eu opean coun ies like he Uni ed
S a es [31]. On he con a y, in a mo e ecen s udy Agga -
wal e al. [15] showed a sligh inc ease in NMSC mo ali y
in he Uni ed S a es.
Imp o emen s in ea ly de ec ion and ea men likely play
a signi ican ole in he obse ed decline in SCC mo ali y
among women and younge men. G ea e awa eness o skin
cance symp oms, inc eased heal h-seeking beha io —pa -
icula ly among women—and widesp ead access o de ma o-
logical ca e may lead o ea lie diagnosis and mo e e ec i e
managemen .
In ou s udy, he excep ion o he gene al decline o
NMSC ASMRs in Eu ope was obse ed in males o e
74yea s o age. In con as , Lei e e al. [13] epo ed a
decline in ASMRs among men o e 74 in Ge many. How-
e e , his p e ious s udy only included ASMRs da a up o
2012. Based on ou indings, a end e e sal in ASMRs
among men o e 75yea s o age in Ge many began in 2010,
ollowed by a pa icula ly ma ked inc ease and a sus ained
ise in a es h oughou he s udy pe iod (1992–2021).
Acco ding o ou esul s, da a ega ding males om
No he n Eu opean coun ies a e pa icula ly conce n-
ing, as hey e eal an inc easing end in mo ali y. Males
bo n a e 1960 exhibi highe ASMRs compa ed o hose
bo n ea lie in he cen u y in ou s udy. Mo eo e , a
pe iod e ec indica es a con inued ise in ASMRs among
No he n Eu opean males in ecen yea s. This conce n-
ing ise in SCC mo ali y among olde men, pa icula ly
in No he n and Wes e n Eu ope, is likely mul i ac o ial.
In addi ion o cumula i e ul a iole adia ion exposu e
and age- ela ed immunosenescence, limi ed engagemen in
p e en i e heal h beha io s—such as sel -examina ion and
egula skin checks—may delay diagnosis in his popula-
ion. Fu he mo e, heal hca e access ba ie s, especially
in u al o unde se ed a eas, could con ibu e o diag-
nos ic and ea men delays. Toge he , hese ac o s may
esul in mo e ad anced-s age p esen a ions and poo e
ou comes in olde men, unde sco ing he need o a ge ed
in e en ions in his demog aphic. In 2017, B unssen e al.
[10] conduc ed a sys ema ic e iew o analyze he ole o
skin cance seconda y p e en ion. The esul s showed ha
sc eening is associa ed wi h an inc ease in he incidence o
NMSC; howe e , e idence ega ding i s impac on mo al-
i y om his disease is limi ed, highligh ing he need o
u he s udies on he subjec . In his con ex , he ole o
seconda y p e en ion in speci ic high- isk g oups, such
as hose highligh ed in his s udy, could be o pa icula
in e es in imp o ing mo ali y da a [32, 33].
The main limi a ion o his s udy is ha he da a om
he GBD a e based on es ima es and ma hema ical mod-
els de i ed om a ious sou ces, meaning no all cases o
skin cance a e likely o ha e been eco ded. Mo eo e , he -
e ogenei y in da a quali y, epo ing s anda ds, diagnos ic
p ac ices, and case coding ac oss he 28 Eu opean coun ies
included in his s udy may a ec he accu acy o coun y-
speci ic es ima es. The comple eness and equency o
upda es o na ional cance egis ies also a y, u he limi -
ing compa abili y. As no ed in he p e ious s udies, unde -
epo ing and inconsis en classi ica ion o NMSC cases
emain signi ican challenges [4, 11–15].
In conclusion, al hough he o e all incidence o BCC
has shown a downwa d end in Eu ope, ou da a e eal
an inc ease among young pa ien s in Cen al, Eas e n, and
No he n Eu ope. SCC incidence, in u n, has exhibi ed a
modes ise among Eu opean males. On he o he hand,
SCC mo ali y also shows a dec easing end, al hough
he e ogeneously, wi h speci ic inc eases in ce ain g oups,
such as men om No he n Eu opean coun ies, especially
hose bo n a e he 1960s. These indings unde sco e he
need o ailo ed public heal h s a egies. In clinical p ac-
ice, enhanced igilance is wa an ed o younge pa ien s
in No he n and Cen al Eu ope and o elde ly men, pa -
icula ly in egions wi h ising SCC mo ali y. Public heal h
au ho i ies should p io i ize ha monized egis y sys ems o
imp o e da a compa abili y, while also de eloping egion-
speci ic p e en ion campaigns, including UV p o ec ion
educa ion and po en ial sc eening ini ia i es in high- isk
popula ions. In eg a ing hese epidemiological insigh s in o
clinical and policy amewo ks may help educe he u u e
bu den o NMSC ac oss Eu ope.
Supplemen a y In o ma ion The online e sion con ains supplemen-
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